[Risk factors of recurrence or metastasis in patients with medullary thyroid carcinoma].

Objective: To analyze the risk factors of recurrence or metastasis of medullary thyroid carcinoma (MTC) and the influencing factors of disease-free survival (DFS). Methods: The clinicopathological data of MTC patients who visited Tianjin Medical University Cancer Institute and Hospital and underwent surgery from August 2014 to August 2019 were retrospectively analyzed. The patients were divided into recurrence or metastasis group and no recurrence or metastasis group. Multivariate logistic regression analysis was used to analyze the risk factors for recurrence or metastasis. Kaplan-Meier survival analysis and Cox regression analysis were used to determine the risk factors of DFS. Results: A total of 158 MTC patients were enrolled in final analysis, including 83 females and 75 males, with a median age of 52 (19-74) years. There were 146 cases of sporadic MTC (92.4%) and 12 cases of familial MTC (7.6%), respectively. Bilateral thyroid lesions presented in 33 cases (20.9%) and multiple lesions presented in 57 cases (36.1%), respectively. The median follow-up time was 59.7 (10.0-93.0) months and the median DFS was 55.5 (0-92.9) months. Presence of multifocality, the largest tumor size>2 cm, T3/4, N1b, clinical stage Ⅲ/Ⅳ, lymph node metastasis ratio (LNR)>0.3, preoperative calcitonin>2 000 ng/L, postoperative calcitonin>40 ng/L and no biochemical cure were significantly correlated with the recurrence or metastasis and DFS of MTC (all P<0.05). Clinical stage Ⅲ/Ⅳ (OR=36.57, 95%CI: 1.33-1 006.98, P=0.033), the largest tumor size>2 cm (OR=5.81, 95%CI: 1.01-33.33, P=0.049), multifocality (OR=3.64, 95%CI: 1.03-12.88, P=0.045) and postoperative calcitonin>40 ng/L (OR=15.03, 95%CI: 1.39-162.61, P=0.026) were independent risk factors of recurrence or metastasis. Clinical stage Ⅲ/Ⅳ (HR=19.39, 95%CI:1.40-268.19, P=0.027), the largest tumor size>2 cm (HR=3.64, 95%CI: 1.02-13.02, P=0.047) and postoperative calcitonin>40 ng/L (HR=10.68, 95%CI: 1.34-84.95, P=0.025) were influencing factors for DFS (all P<0.05). Conclusion: The larger tumor size, advanced clinical stage and higher postoperative calcitonin at the initial treatment of MTC are risk factors for recurrence or metastasis and influencing factors for DFS.

[Chimeric perforator flap based on the descending branch of lateral circumflex femoral artery for tongue reconstruction after advanced tongue cancer resection].

Objective: To explore the advantages and clinical efficacy of free chimeric perforator flap based on the descending branch of circumflex femoral artery applied to tongue reconstruction after advanced tongue cancer resection. Methods: From October 2013 to December 2018, 57 cases received tongue and oral base reconstruction surgeries using the descending branch of circumflex femoral artery chimeric perforator flap, including 39 males and 18 females, ranged from 20 to 76 years old. And all cases were with stage T3 and T4 tongue cancers, including 35 cases of squamous cell carcinoma, 7 cases of low differentiation cancer, 5 cases of oncosarcoma, and 10 cases of adenoid cystic carcinoma. The tongue was reconstructed by using perforator flap and muscle flap to fill the dead space at the oral floor. The artery anastomoses with the superior thyroid artery or facial artery in the receiving area, and the vein anastomoses with the internal jugular vein in the receiving area. The shape, function and local complications of the reconstructed tongue were observed after operation. Results: Of 57 cases, only one case had partial necrosis of flap, while other 56 cases with chimeric perforator flap survived. Postoperative gastric tube and tracheal cannula were removed in all patients, no cases with oral fistula. All donor sites were sutured in one stage. Postoperative radiotherapy was performed in 41 of the patients. All patients were followed up for 3 to 60 months (average of 20.7 months), with satisfactory esthetic and functional results in reconstructed tongues. Only linear scars were left in the donor areas of the legs, and no lower limb dysfunction was observed. Conclusions: The descending branch of circumflex femoral artery chimeric perforator flap can used for repairing simultaneously the defects of both tongue and oral base. It is helpful to avoid the occurrence of oral fistula and to provide the reconstructed tongue with a good function. It is a good choice to use the descending branch of circumflex femoral artery chimeric perforator flap for tongue reconstruction after resection of advanced tongue cancer resection.

[Analysis of risk factors for central lymph node metastasis in papillary thyroid microcarcinoma].

Objective: To analyze the risk factors of lymph node metastasis in central region of patients with papillary thyroid microcarcinoma (PTMC). To evaluate the reliability of different risk factors on the prognosis of cervical lymph node metastasis in PTMC patients, and to provide the clinical support for PTMC in the central area. Methods: The clinical data of 700 patients with PTMC treated with surgery from January 2015 to July 2017 were analyzed retrospectively. Risk factors for lymph node metastasis in central region were analyzed by single factor analysis, multivariate Logistic regression analysis and receiver operating characteristic curve (ROC) curve. Results: Central lymph node metastasis (CLNM) rate was 48.29% (338/700). Multifactor analysis indicated that age≤45 years old, male, multifocality, capsule invasion, the tumor calcification and tumor diameter ≥5 mm were independent risk factors for CLNM in patients with PTMC. In the risk prediction of CLNM, the optimal critical value of diameter prediction was 7 mm and the area under the curve (AUC) of ROC=0.647. The optimal threshold for age prediction was 41 years old and AUC=0.597. Single factor analysis for ROC curve showed that gender factor AUC=0.588, tumor number factor AUC=0.627, tumor location factor AUC=0.613. and calcification factor AUC=0.603. The ROC curve of multiple risk factors was analyzed according to age, gender, diameter, location, number of cancer foci and calcification, and AUC=0.768. Conclusions: Age less than 45 years old, male, multiple cancer foci, focal invasion and capsule invasion, calcification, and tumor diameter ≥5 mm are independent risk factors for CLNM of PTMC. With an accumulation of multiple risk factors, CLNM risk increases, and central lymph node dissection should be recommend.

Pharmacokinetic studies of norethisterone-3-oxime and norethisterone-3-oxime acetate in rhesus monkey.

After [6,7-3H]-labelled norethisterone-3-oxime (NETO) and norethisterone-3-oxime acetate (NETO-AC) were given intravenously or orally through a nasal tube with 1 mg of respective unlabelled steroid to Rhesus monkey, serum samples were collected at various periods, and radioactivity was counted with or without reverse-phase HPLC separation in advance. Pharmacokinetics of NETO and NETO-AC were compared with those of norethisterone (NET) and norethisterone acetate (NET-AC) respectively which were studied in a similar experimental design. The results indicated that the serum concentration-time curve of NETO and NET could be adequately described by a two-compartment model. Average t 1/2 ka, t 1/2 alpha and t 1/2 beta with standard deviation for oral administration were 0.21 +/- 0.08 (h), 1.28 +/- 0.31 (h) and 10.01 +/- 4.59 (h) for NET and 0.37 +/- 0.81 (h), 0.90 +/- 0.26 (h) and 8.55 +/- 2.21 (h) for NETO respectively. NETO metabolized to NET which had a similar serum profile with its precursor. NET-AC also metabolized to NET, but more rapidly. It disappeared from blood 8-12 h after nasal feeding. NETO-AC was non-detectable at all when given orally because it metabolized immediately and extensively in the animal body. Its major metabolites, NETO, NET and NET-AC already appeared in the first blood sample drawn 15 min after administration. NETO-AC, when injected intravenously, declined abruptly and could not be detected 4 h later. Among the metabolites, only the deacetylated products (NET and NETO) reached relatively higher levels and sustained longer in blood.(ABSTRACT TRUNCATED AT 250 WORDS)

[Pharmacokinetics of norethindrone-3-oxime and norethindrone in rhesus monkeys].

After intravenous administration or nasal feeding of (6, 7-3H)-labelled norethindrone-3-oxime (NETO) or norethindrone (NET) to rhesus monkeys, the serum concentrations were determined by measuring the radioactivity after separation with HPLC. The serum concentrations of total extractable radioactivity were also measured without HPLC separation. In cases of nasal feeding, NETO and NET were quickly absorbed, and almost all of them were eliminated within 24 hours. NETO, when given via both routes, was partly metabolized to NET and partly remained in original form. The blood concentration--time curves for NETO and NET were adequately fitted to two compartment models. No significant difference in pharmacokinetic parameters between the two drugs was observed. The absolute bioavailability for NETO and NET were found to be 64.46 +/- 34.60% and 35.02 +/- 26.49% respectively.

Efficacy of inactivated vaccine containing cyto-hemagglutinin against epidemic hemorrhagic fever in rabbits.

Using the Z-10 strain of epidemic hemorrhagic fever virus (EHFV) as seed, and the primary cell of Meriones unguiculatus kidney tissue as incubation cell, a propiolactone inactivated epidemic hemorrhagic fever (EHF) vaccine was prepared, according to a similar procedure required for the production of biological products such as the Japanese B encephalitis vaccine. Besides the EHFV antigen detected by ELISA or reversed passive hemagglutination test (RPHA) as were used for the formalin inactivated vaccine, higher titres (1:128-1:1024) of EHFV hemagglutinin antigen was also detected in this EHFV vaccine. Immunization with twice intramuscular injection of this vaccine produced high titred (1:20-1:160) neutralizing antibody and low titred (1:10-1:20) hemagglutination antibody, in addition to the immunofluorescence (IF) and reversed passive hemagglutination inhibition (RPHI) antibodies. These results indicated an apparent difference in the immunogenicity between the beta-propiolactone and formalin inactivated EHF vaccines. With the approval of the Ministry of Health, human test is now underway in this laboratory.